| NPI | 1154387629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 9219) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 26979) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-09 |