| NPI | 1376956763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME155045) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL36995) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-03-14 |