| NPI | 1639867914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 77435) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 33473) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2024-07-31 |