| NPI | 1114120334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 40863) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CO 48507) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2022-08-28 |