| NPI | 1285834754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN 2115) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 2115) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2012-02-06 |