| NPI | 1649707506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10060963) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.148090) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2024-11-06 |