| NPI | 1639305576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 077235) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 120151) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2017-04-07 |