| NPI | 1720321102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D98197) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD482093) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD482093) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2023-09-28 |