| NPI | 1740713957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX U3581) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 2023-00062) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-08-28 |