| NPI | 1316963879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 200600765) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 220941) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 200600765) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-06-14 |