| NPI | 1265644967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 70065) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD445469) |
| 208600000X Surgery (Licence: CT 70065) | |
| 208200000X Plastic Surgery (Licence: PA MD445469) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2022-04-12 |