| NPI | 1952583932 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD H72202) | 
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 242456) | 
| Enumeration Date | 2007-11-30 | 
| Last Update Date | 2019-10-11 |