| NPI | 1720168958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34002298) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS3512) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX F2636) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-09-11 |