| NPI | 1982813853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD432065) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 036-109354) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2019-10-01 |