| NPI | 1427201011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 249272) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 236964) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2020-12-03 |