| NPI | 1366431272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 27893) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 056381) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2014-04-08 |