| NPI | 1316283286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA MD.013301) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA MD.013301) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: LA MD.013301) | |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2018-01-29 |