| NPI | 1235485137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN 62868) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX BP20066599) |
| 208200000X Plastic Surgery (Licence: TX BP10052157) | |
| 208600000X Surgery (Licence: PA MT202718) | |
| Enumeration Date | 2012-07-28 |
| Last Update Date | 2022-04-11 |