| NPI | 1760775035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX R1941) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX BP10037405) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2021-12-06 |