| NPI | 1003179300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60937352) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R6336) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-04-28 |