| NPI | 1871749663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME122042) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KS 04-32928) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2021-03-30 |