| NPI | 1275655912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D0093554) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NE 32031) |
| 208200000X Plastic Surgery (Licence: CA A121376) | |
| 208200000X Plastic Surgery (Licence: NY 259123) | |
| 208600000X Surgery (Licence: MI 4301082483) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2022-11-22 |