| NPI | 1700027745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N9541) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX BP20024534) |
| 208200000X Plastic Surgery (Licence: CA A114929) | |
| 208200000X Plastic Surgery (Licence: MD D71832) | |
| 208200000X Plastic Surgery (Licence: MO 2012003245) | |
| Enumeration Date | 2009-03-22 |
| Last Update Date | 2014-07-07 |