| NPI | 1528103298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101012845) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 5101012845) |
| 208200000X Plastic Surgery (Licence: OH 34-007972) | |
| 208200000X Plastic Surgery (Licence: FL OS9321) | |
| 208600000X Surgery (Licence: TX N6386) | |
| 208600000X Surgery (Licence: OH 34-007972) | |
| 208600000X Surgery (Licence: FL OS 9321) | |
| 208200000X Plastic Surgery (Licence: TX N6386) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2021-04-14 |