| NPI | 1154852788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX V0118) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 282168) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 58133) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-05-09 |