| NPI | 1942402433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 8217905-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 50393) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2023-01-05 |