| NPI | 1124003421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D0023431) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NH 22431) |
| 208200000X Plastic Surgery (Licence: DC MD10918) | |
| 208200000X Plastic Surgery (Licence: WI 2909) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2023-04-12 |