| NPI | 1568624682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P1023) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 218605) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2017-02-21 |