| NPI | 1023348158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA OS-004-046-L) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS-004-046-L) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2018-03-23 |