| NPI | 1679754212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WV 26356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260886) |
| 208200000X Plastic Surgery (Licence: MD D71417) | |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2018-10-16 |