| NPI | 1407919020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301024493) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301024493) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-03-10 |