| NPI | 1801180674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD0451501) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT199108) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-07-21 |