| NPI | 1003348772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2024-01895) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX U1497) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2024-07-31 |