| NPI | 1962700062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 140746) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R72006) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2020-07-21 |