| NPI | 1770973190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DC MD500003365) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D0100771) |
| Enumeration Date | 2015-01-24 |
| Last Update Date | 2024-07-18 |