| NPI | 1861512964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD432491) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN MD0000041273) |
| 208600000X Surgery (Licence: TN MD0000041273) | |
| 208600000X Surgery (Licence: PA MD432491) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2023-01-29 |