| NPI | 1275890816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX S2710) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD462905) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD210001748) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D0092927) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA09901800) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101273317) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2026-05-20 |