| NPI | 1700306347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 82491) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2017021026) |
| Enumeration Date | 2017-06-25 |
| Last Update Date | 2023-09-29 |