| NPI | 1689724254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DC MD33131) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101231575) |
| 208200000X Plastic Surgery (Licence: MD D57780) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2021-11-23 |