| NPI | 1669457487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D82435) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101057957) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2017-08-30 |