| NPI | 1053386409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD040737L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD040737L) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2023-10-20 |