| NPI | 1962478636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 8501536-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N1138) |
| 208600000X Surgery (Licence: TX N1138) | |
| 208D00000X General Practice (Licence: TX N1138) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-08-12 |