| NPI | 1871147876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2019011349) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OR 197514) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2021-04-28 |