| NPI | 1063506905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME105409) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 49498) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX N2130) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-01-27 |