| 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 |