| NPI | 1356760664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD61015353) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA10630300) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-04-08 |