| NPI | 1538207808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA a92015) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX M1906) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2018-03-17 |