| NPI | 1144233537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G87752) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 35136) |
| 208200000X Plastic Surgery (Licence: FL ME 69692) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2008-01-18 |