| NPI | 1205209137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OR MD204003) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA 1) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2022-06-15 |