| NPI | 1235104902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX L1993) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX L1993) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2014-10-14 |