| NPI | 1538162201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX E4435) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 11854) |
| 208200000X Plastic Surgery (Licence: CA 37362) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2024-06-11 |