| NPI | 1407988439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CO 41687) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 190056) |
| 208200000X Plastic Surgery (Licence: CA G87689) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2009-11-20 |