| NPI | 1316144645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA MD.206372) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL30050) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-01-03 |