| NPI | 1699189456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 5101020975) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020975) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2026-02-03 |