| NPI | 1497711808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 14855) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 39968) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-09 |