| NPI | 1245285048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A92907) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 271451) |
| 208200000X Plastic Surgery (Licence: AL 22756) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2019-11-13 |