| NPI | 1265687719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2013022097) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KS 0436704) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2013-08-09 |