| NPI | 1508066176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX p3374) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 264705) |
| 208200000X Plastic Surgery (Licence: TX p3374) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2018-08-02 |