| NPI | 1861798696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101254231) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 10240804-1205) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2020-08-25 |