| NPI | 1730101213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 200300784) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 2003-00784) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-07-21 |