| NPI | 1700831294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KS ks0429556) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS KS0429556) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2022-02-17 |