| NPI | 1962822684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T1314) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T1314) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10050299) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2023-03-23 |