| 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 |