| NPI | 1588009658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 63177) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD466762) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-11-22 |