| NPI | 1679673289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301066100) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 100858) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2023-06-20 |