| NPI | 1972063097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 67725) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 30013) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2020-08-24 |