| NPI | 1942228168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 35467) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MN 35467) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-11-16 |