| NPI | 1851618649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P5223) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD427397) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2021-03-08 |