| NPI | 1700964103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N4334) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD459490) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX N4334) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-12-14 |