| NPI | 1770513822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD425687) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD425687) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2012-11-05 |