| NPI | 1770100133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 69993) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 30866) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2021-08-26 |