| NPI | 1104884956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD 60288108) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 057743) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2012-09-11 |