| NPI | 1326468521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX S7578) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX BP10050873) |
| Enumeration Date | 2014-04-26 |
| Last Update Date | 2021-09-23 |