| NPI | 1154589950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T3999) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD448858) |
| 208200000X Plastic Surgery (Licence: TX T3999) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2022-10-28 |