| NPI | 1225040447 |
|---|---|
| Former Name | MICHAEL LEE SELF |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AR E-5606) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L5552) |
| 208600000X Surgery (Licence: AR E-5606) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2010-09-24 |