| NPI | 1649581562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD MD175607) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD 0000000000) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2018-03-02 |