| NPI | 1154852705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX U9214) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 28451) |
| 208200000X Plastic Surgery (Licence: MN 64276) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-08-16 |