| NPI | 1417213372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 65755) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX S0254) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2020-05-10 |