| NPI | 1104970540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A110375) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 060344) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2010-04-12 |