| NPI | 1639221013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX S6474) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301104143) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-03-27 |