| NPI | 1407111248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AZ 55056) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: LA MD.206596) |
| 208200000X Plastic Surgery (Licence: MA 250899) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2019-12-19 |