| NPI | 1427386523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX N4409) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX N4409) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2011-03-16 |