| NPI | 1649303694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AK 168881) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI 11981) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2023-02-01 |