| NPI | 1255778361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: RI MD17031) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 285530) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-12-14 |