| NPI | 1801243472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 70488) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 70412) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2026-04-20 |