| NPI | 1912921644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 75472) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101055986) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-03-06 |