| NPI | 1932275088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: ND 11155) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 28419) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2019-03-01 |