| NPI | 1104013499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX M6787) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M6787) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2023-12-06 |