| NPI | 1104082783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KS 04-38314) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX P3185) |
| 208200000X Plastic Surgery (Licence: MO 2015026143) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2020-10-14 |