| NPI | 1518985720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 27468) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 37652) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-12-09 |