| NPI | 1922716794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX PENDING) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX PENDING) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2023-03-05 |