| NPI | 1578510202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD d0045135) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101053872) |
| 208200000X Plastic Surgery (Licence: DC md20198) | |
| 208200000X Plastic Surgery (Licence: MA 80944) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2021-01-04 |