| NPI | 1417937376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 33262) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 33262) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2014-03-13 |