| NPI | 1972935583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0116032011) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121293) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2018-06-26 |