| NPI | 1861784449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: IN 02005587A) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101019137) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2019-04-17 |