| NPI | 1720073463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101230226) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D0057504) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2019-05-13 |