| NPI | 1518172154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN 44291) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD427250) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2018-11-01 |