| NPI | 1720131451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: ND 11062) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NV 10799) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-10-12 |