| NPI | 1427137694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N3563) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 47699-020) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2014-10-02 |