| NPI | 1477800134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-15773) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036145857) |
| 208600000X Surgery (Licence: PA MT201381) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ID M-15773) | |
| Enumeration Date | 2012-08-12 |
| Last Update Date | 2021-06-23 |