| NPI | 1295786960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P0968) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101239398) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-06-18 |