| NPI | 1609866995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX P8948) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2018-02056) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO DR.0071318) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2024-08-14 |