| NPI | 1154564656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A115318) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 106907) |
| 208200000X Plastic Surgery (Licence: TX BP10041657) | |
| 208200000X Plastic Surgery (Licence: MN 56901) | |
| 208600000X Surgery (Licence: MI 4301092879) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2021-09-16 |