| NPI | 1487623765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AZ AZ23804) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 23804) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2016-10-05 |