| NPI | 1790002954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DE C10012570) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DE C1-0012570) |
| 208600000X Surgery (Licence: DE 1790002954) | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2022-08-11 |