| NPI | 1598895310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME.136834) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AL MD.31966) |
| 208200000X Plastic Surgery (Licence: TX N9523) | |
| 208200000X Plastic Surgery (Licence: KS 6453) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-28 |