| NPI | 1881987832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A116233) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A116233) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2022-07-21 |