| NPI | 1669432977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD38631-E) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD038631-E) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-05-26 |