| NPI | 1972506228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX G5975) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G5975) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2026-01-27 |