| NPI | 1972899342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2018-01471) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL33803) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2023-09-01 |