| NPI | 1548391980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL MFC1851) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA LT000631) |
| 208200000X Plastic Surgery (Licence: PA MD432684) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-12-09 |