| NPI | 1639566094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301505386) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 80721) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2024-08-14 |