| NPI | 1043299555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 30848) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 60797-20) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2021-03-11 |