| NPI | 1831192525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T2821) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G55894) |
| 208200000X Plastic Surgery (Licence: TX T2821) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2025-06-20 |