| NPI | 1184602351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 7903019-1205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 47680) |
| 208600000X Surgery (Licence: MN 47680) | |
| 208600000X Surgery (Licence: UT 7903019-1205) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2019-06-19 |