| NPI | 1497952568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R1451) |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 57186-20) |
| 208200000X Plastic Surgery (Licence: TX 44739) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-10-15 |