| NPI | 1073797221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2010017986) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD436884) |
| 208200000X Plastic Surgery (Licence: CA A87415) | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2021-01-15 |