| NPI | 1598949679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 60174) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 060174) |
| Enumeration Date | 2007-12-25 |
| Last Update Date | 2019-12-13 |