| NPI | 1770780652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 50762) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 50762) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2017-11-01 |