| NPI | 1194719336 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301401936) |
| Additional Taxonomies | 174400000X Specialist (Licence: 4301401936) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2023-11-27 |