| NPI | 1053473504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 74518) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME74668) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2017-04-27 |