| NPI | 1497072037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KS 04-17694) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2006003833) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2010-04-21 |