| NPI | 1467982082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: RI MD19385) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT LP04089) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-06-30 |