| NPI | 1720020878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX N6334) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35086203) |
| 208200000X Plastic Surgery (Licence: TX N6334) | |
| 208600000X Surgery (Licence: OH 35086203) | |
| 208600000X Surgery (Licence: TX N6334) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2021-09-17 |