| NPI | 1083945968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P0754) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX P0754) |
| Enumeration Date | 2010-01-16 |
| Last Update Date | 2019-02-22 |