| NPI | 1578765129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX T2450) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: LA 303222) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-08-09 |