| NPI | 1043534589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX Q8960) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD Unlicensed) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2024-02-28 |