| NPI | 1386038768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 145235) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 145235) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2016-10-03 |