| NPI | 1588985402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 67727) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 27844) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2022-07-21 |