| NPI | 1316021918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 20948020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 15946) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |