| NPI | 1710966866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: GA 28886) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: SC 37644) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2021-03-31 |