| NPI | 1558369371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 56396) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: IL 036-079730) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2021-04-29 |