| NPI | 1720291792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301083724) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301083724) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-07-30 |