| NPI | 1821254517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 54960) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NM MD2012-0616) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 45114) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2018-04-05 |