| NPI | 1720428386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OR DO203270) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR DO203270) |
| 208600000X Surgery (Licence: TN 3455) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA OP61265139) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-02-09 |