| NPI | 1235420886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME136100) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 55765) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2020-10-20 |