| NPI | 1114286051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 5101019887) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101019887) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: UT 11725359-1204) | |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2021-11-04 |