| NPI | 1760914378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 74281) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 71843-20) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2023-08-22 |