| NPI | 1801058581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX Q1993) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 305277) |
| 208200000X Plastic Surgery (Licence: TN MD0000063029) | |
| 208200000X Plastic Surgery (Licence: VA 0101273129) | |
| 208200000X Plastic Surgery (Licence: FL ME153167) | |
| 208200000X Plastic Surgery (Licence: GA 70263) | |
| 208200000X Plastic Surgery (Licence: MS 29430) | |
| 208600000X Surgery (Licence: TX Q1993) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2022-04-29 |