| NPI | 1497842512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NM MD2010-0793) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TN MD38986) |
| 2086S0127X Surgery, Trauma Surgery (Licence: PA MD071147L) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: NM MD2010-0793) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2023-01-23 |