| NPI | 1194943555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101243422) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D67453) |
| 208200000X Plastic Surgery (Licence: DC MD037222) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2016-07-24 |