| NPI | 1306819461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301054838) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI ST054838) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2015-04-06 |