| NPI | 1962563528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME140728) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CO 27280) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2023-01-10 |