| NPI | 1962730820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 264815) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT013221) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2017-06-06 |