| NPI | 1649567355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 49916) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P4473) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 49916) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2021-07-01 |