| NPI | 1497718258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 053185) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 053185) |
| 208600000X Surgery (Licence: SC 21093) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 053185) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2008-01-17 |