| NPI | 1417110974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL 149705) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 036124471) |
| 208200000X Plastic Surgery (Licence: MD D0083687) | |
| Enumeration Date | 2008-07-04 |
| Last Update Date | 2021-03-25 |