| NPI | 1760456784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX S3547) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD419763) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD419763) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2019-10-11 |