| NPI | 1578857371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 14203851) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R9559) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2025-07-17 |