| NPI | 1053390278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX K8672) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX K8672) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2008-10-16 |