| NPI | 1205911401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX C9674) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX C9674) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-05-02 |