| NPI | 1427080647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD037971) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101238846) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-03-17 |