| NPI | 1932190915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q1848) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101052914) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2018-12-07 |