| NPI | 1417053620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 033266) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 033266) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-03-02 |