| NPI | 1366651549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME120264) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IA 40696) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-07-17 |