| NPI | 1154557502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T2218) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.145422) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2022-04-11 |