| NPI | 1508845009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2003015832) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CO DR.0062008) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2019-04-12 |