| NPI | 1366609588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D0069913) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC MD038382) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2013-11-15 |