NPI | 1083994271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101274320) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC MD210002211) |
208200000X Plastic Surgery (Licence: MD D0093948) | |
208200000X Plastic Surgery (Licence: NC 2018-02093) | |
Enumeration Date | 2011-08-19 |
Last Update Date | 2022-04-13 |