| NPI | 1881785772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2012005895) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KS 0435520) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-06-05 |