| NPI | 1285990523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OR MD184490) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR MD184490) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2019-10-18 |