| NPI | 1649614132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 87705) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R6411) |
| 208600000X Surgery (Licence: TX R6411) | |
| 208600000X Surgery (Licence: GA 87705) | |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2024-12-03 |