| NPI | 1194756320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PA MD041256E) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD-04125-E) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-30 |