| NPI | 1023278215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P6908) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A112867) |
| 208600000X Surgery (Licence: TX P6908) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2024-03-27 |