| NPI | 1396879284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 71689) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0016496) |
| 208200000X Plastic Surgery (Licence: WI 18328) | |
| 208200000X Plastic Surgery (Licence: SC 39832) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2019-10-09 |