| NPI | 1770567604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 58456) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 58456) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WI 73211) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2021-08-18 |