| NPI | 1134205057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D0059925) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101234281) |
| 208200000X Plastic Surgery (Licence: DC MD34146) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-08 |