| NPI | 1407059280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX M6030) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX M6030) |
| 207P00000X Emergency Medicine (Licence: TX M6030) | |
| 208600000X Surgery (Licence: TX M6080) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2023-06-14 |