| NPI | 1457353690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G130233) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: SD 4052) |
| 208200000X Plastic Surgery (Licence: FL ME121389) | |
| 208200000X Plastic Surgery (Licence: MN 37847) | |
| 208200000X Plastic Surgery (Licence: ND 6638) | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-03-07 |