| NPI | 1144225228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 17862) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: SC MD17862) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 17862) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2024-04-02 |