| NPI | 1699903781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AL MD36097) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME 123652) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2020-01-03 |