| NPI | 1275506362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2009-01310) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD418843) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2013-02-21 |