| NPI | 1578981957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D0091047) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101271614) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD049116) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-09-30 |