| NPI | 1942543681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A167926) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IN 01083848A) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: IN 01083848A) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CT 1.062965) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2021-04-06 |