| NPI | 1912193624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q3159) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP20028154) |
| 208200000X Plastic Surgery (Licence: MN 106220) | |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2019-05-21 |