| NPI | 1861951626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101284996) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D0103143) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD600003884) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-06-19 |