| NPI | 1336343938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 40717) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP1-0016836) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2016-12-30 |