| NPI | 1518072990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 235149) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OR MD25320) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2015-05-28 |