| NPI | 1720399967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 99334) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT198203) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AR E-11668) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2024-04-24 |