| NPI | 1467458273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G61854) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G061854) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2014-09-04 |