| NPI | 1376802769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX BP10043205) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX R4216) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-02-07 |