| NPI | 1821015561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101239935) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101239935) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-12-13 |