| NPI | 1750362935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD037993E) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD037993E) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-03-07 |