| NPI | 1457593238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NV 17930) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 47951) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2021-05-04 |