| NPI | 1992915938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX s2672) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 107149) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-02-05 |