| NPI | 1669401881 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A96118) | 
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101232282) | 
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD036077) | |
| Enumeration Date | 2006-07-01 | 
| Last Update Date | 2023-08-29 |