| NPI | 1245446574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD426599) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD426599) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: VA 0101242428) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-11-06 |