| NPI | 1265598130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 049538) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MT185935) |
| 208200000X Plastic Surgery (Licence: CT MD 049538) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2019-10-11 |