| NPI | 1942366802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101241205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 1942366802) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2018-11-28 |