| NPI | 1952753774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IA MD48259) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL 14228) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2021-11-09 |