| NPI | 1184704009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 20010-00335) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI unknown) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2014-04-15 |