NPI | 1801155064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 13930346-1205) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 62006) |
Enumeration Date | 2012-05-09 |
Last Update Date | 2024-06-10 |