| NPI | 1124108253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G28409) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G28409) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-09 |