| NPI | 1093943227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX R2465) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301111348) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2023-05-15 |