| NPI | 1194102483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T4070) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 75241) |
| 208200000X Plastic Surgery (Licence: TX T4070) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-08-21 |