| NPI | 1487034153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: ND 18537) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 60833) |
| 208200000X Plastic Surgery (Licence: UT 12256619-1205) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-10-25 |