| NPI | 1295943124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101238829) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D0068752) |
| 208200000X Plastic Surgery (Licence: DC MD036619) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2011-11-01 |