| NPI | 1316110638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX M5522) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M5522) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2015-01-13 |