| NPI | 1356336317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 35062) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G70657) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2024-02-06 |