| NPI | 1083729412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 200800100) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PR 9330) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-07-21 |