| NPI | 1487625075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 17258) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 17258) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2018-03-17 |