| NPI | 1003814062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD3164) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC DC31641) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC 31641) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2025-12-03 |