| NPI | 1801005616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301100193) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 058525) |
| 208600000X Surgery (Licence: MI 4301100193) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-07-31 |