| NPI | 1164573424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301071818) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A82940) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2009-10-28 |