| NPI | 1457645715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 257515) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NH 19074) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2021-08-18 |