| NPI | 1932561487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2023028647) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KS 04-47980) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-09-03 |