| NPI | 1730187477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 045759) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 45759) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-07-21 |