| NPI | 1275695546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 8601785-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 228958) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2021-11-17 |