| NPI | 1740608231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 68599) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC MD047885) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-03-13 |