| NPI | 1215466131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX U9278) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76327) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2024-06-27 |