| NPI | 1497775852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO 063613) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WV 26219) |
| 208200000X Plastic Surgery (Licence: SC 35691) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-03-24 |