| NPI | 1841281227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 74194) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NH 19264) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2018-11-30 |