| NPI | 1972611481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SD 9162) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IA 39703) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NE 27081) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-05-19 |