| NPI | 1083779623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MI 4301047649) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301047649) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2009-02-28 |