| NPI | 1508094319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX R4560) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.056705) |
| 208600000X Surgery (Licence: TX R4560) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2019-08-02 |