| NPI | 1023337417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX BP10038007) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: LA 300030) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2021-04-07 |