| NPI | 1972769917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 11847500-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA os014237) |
| 208200000X Plastic Surgery (Licence: UT 118475001204) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2020-11-10 |