| NPI | 1538546643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 67089 - 20) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 5749-851) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2017-03-20 |