| NPI | 1013335280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2022-01355) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 11250304-1205) |
| 208600000X Surgery (Licence: NC 201098) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2022-09-09 |