| NPI | 1619395175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OK 34899) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME EL191030) |
| 208600000X Surgery (Licence: ME MD23272) | |
| 208600000X Surgery (Licence: MO 2019022418) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2020-12-03 |