| NPI | 1205035102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2013-00923) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX P6658) |
| 208600000X Surgery (Licence: SC LL28527) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2013-00923) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX P6658) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2020-10-25 |