| NPI | 1730416553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD438251) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD438251) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2016-03-03 |