| NPI | 1912170119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2010-01097) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 43863) |
| 208600000X Surgery (Licence: NC 2010-01097) | |
| 208600000X Surgery (Licence: TN 43863) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2020-10-25 |