| NPI | 1306853916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA GA 059253) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD429289) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-12-13 |