| NPI | 1871751180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 277293) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101242673) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2019-01-29 |