| NPI | 1659525640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: ND 13601) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 7152271-1205) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2019-02-25 |