| NPI | 1588898043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R6643) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IN 11018186A) |
| 208600000X Surgery (Licence: PA MD454497) | |
| 208600000X Surgery (Licence: PA MT194444) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2019-08-07 |