| NPI | 1871013912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD61406621) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2017016699) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-05-24 |