| NPI | 1700265741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KS 04-43751) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10052652) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2021-06-18 |