| NPI | 1578728853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 240847) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A89839) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2019-11-08 |