| NPI | 1871170639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 72693) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 31582) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2022-10-11 |