| NPI | 1962465153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA 021122) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 59671) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2021-04-28 |