| NPI | 1386620490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX M9301) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0116018584) |
| 208600000X Surgery (Licence: AZ 30531) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2012-07-18 |