| NPI | 1629404603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME163182) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03230465) |
| 208200000X Plastic Surgery (Licence: TX T5554) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T5554) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2023-08-16 |