| NPI | 1194925743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101244227) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101244227) |
| 208600000X Surgery (Licence: VA Not yet issued) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2022-04-06 |