| NPI | 1831456433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX S8105) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX S8105) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2025-01-23 |