| NPI | 1982855334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2017-00063) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2017-00063) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MT 35293) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2021-12-01 |