| NPI | 1255774725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PR 21271) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX R9739) |
| 208200000X Plastic Surgery (Licence: OH 35.131784) | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2024-07-31 |