| NPI | 1740454750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101244834) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D68504) |
| 208600000X Surgery (Licence: MD D68504) | |
| 208600000X Surgery (Licence: VA 0101244834) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2017-04-01 |