| NPI | 1871837377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX R4439) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX 45387) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX BP10045281) | |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2021-05-12 |