| NPI | 1801250493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 1014963) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 62911) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-06-22 |