| NPI | 1316103799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A141766) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A141766) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2023-07-27 |