| NPI | 1518127984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD462098) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX Q9206) |
| 208600000X Surgery (Licence: HI MDR5480) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2023-10-24 |