| NPI | 1174737548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 7324045-1205) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MT184080) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2009-07-20 |