| NPI | 1164738555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KS 04-40029) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2017018138) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2022-07-21 |