| NPI | 1659691228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 69679) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WI 69679) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MT197712) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2024-02-23 |