| NPI | 1720387061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME134603) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.059766) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2021-05-24 |