| NPI | 1245336395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 24905) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301042756) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-04-20 |