| NPI | 1871222729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DC MTL400001281) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC 400001281) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2022-06-07 |