| NPI | 1295047645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX S7392) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 263140) |
| 208600000X Surgery (Licence: PA MD484489) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2024-06-13 |