| NPI | 1316948532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2012-00143) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 00243105) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2014-05-16 |