| NPI | 1174701973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: HI MD-15831) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 390200000X) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2021-05-12 |