| NPI | 1063807436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T1553) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX T1553) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-11-11 |