| NPI | 1326337064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 310245) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 67419) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2018-09-13 |