| NPI | 1669822581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T4374) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX T4374) |
| 208200000X Plastic Surgery (Licence: MO 2016018407) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-10-04 |