| NPI | 1538587928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301501866) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 100883) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2023-07-20 |