| NPI | 1477655660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ND 6735) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: ND 6735) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2019-12-12 |