| NPI | 1356547947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NM MD2015-0050) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101253973) |
| 208200000X Plastic Surgery (Licence: NC 2012-00384) | |
| 208600000X Surgery (Licence: OK 25651) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2021-06-04 |