| NPI | 1366441321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 036762) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 17071) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-12-12 |