| NPI | 1306085535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P5056) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX P5056) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2020-08-11 |