| NPI | 1801185228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2021-01783) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 125.071419) |
| 208200000X Plastic Surgery (Licence: TN 57634) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A122767) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-10-20 |