| NPI | 1639582125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT205735) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A167136) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-12-20 |