| NPI | 1982017133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 67819) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 67819) |
| 208600000X Surgery (Licence: PA MT207322) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2024-11-11 |