| NPI | 1750511556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 67586) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101260819) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2024-01-18 |