| NPI | 1861080046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME159448) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX BP10073091) |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2022-10-27 |