| NPI | 1770847709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301503947) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL34939) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-03-09 |