| NPI | 1487749891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: IA 38423) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO T2002012492) |
| 208600000X Surgery (Licence: IA 38423) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-11-16 |