| NPI | 1932629250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 335927) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT214528) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-06-29 |