| NPI | 1386640118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DC MD036316) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX L3777) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2019-10-22 |