| NPI | 1780609602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101244269) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D00064689) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-06-26 |