| NPI | 1376518704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 25755) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D36862) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D36862) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2022-04-05 |