| NPI | 1841647633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301508791) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.144693) |
| Enumeration Date | 2016-05-21 |
| Last Update Date | 2023-11-09 |