| NPI | 1083787048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX L4198) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: HI 13456) |
| 208200000X Plastic Surgery (Licence: CA A61602) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |