| NPI | 1831192525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX T2821) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G55894) |
| 174400000X Specialist (Licence: KS 04-24238) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-02-09 |