| NPI | 1184621757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 82763) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA OS010619L) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 82763) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2024-05-21 |