| NPI | 1053452615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2013--01297) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 49702) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2013-11-19 |