| NPI | 1487039640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A196882) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 264995) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2024-06-21 |