| NPI | 1720364367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX U1064) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX U1064) |
| 208200000X Plastic Surgery (Licence: TN MD50989) | |
| 208600000X Surgery (Licence: TX U1064) | |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2023-05-22 |