| NPI | 1912490475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MT215129) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ R79943) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2023-10-16 |