| NPI | 1104560358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4351050054) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4351050054APP22) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2022-06-17 |