| NPI | 1841557964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: DC MD048338) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A154262) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2020-08-27 |