| NPI | 1154309896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN MD0000014474) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000014474) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2017-05-12 |