| NPI | 1386640936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AZ 64531) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NV 22100) |
| 208200000X Plastic Surgery (Licence: CA G-181260) | |
| 208200000X Plastic Surgery (Licence: FL ME64773) | |
| 208200000X Plastic Surgery (Licence: VA 0101052468) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2023-09-27 |