| NPI | 1972525392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101043817) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD 52-2003266) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD17938) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D0032266) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-07-10 |