| NPI | 1568428696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OK 11505) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OK 11505) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-06-11 |