| NPI | 1790933034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101254395) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA 60383901) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2024-05-09 |