| NPI | 1073741245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD437346) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 31334) |
| 208600000X Surgery (Licence: PA MD437346) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2023-10-02 |