| NPI | 1649353525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 22413) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OR MD22413) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-03-14 |