| NPI | 1205863636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 22604) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G44313) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2018-03-22 |