| NPI | 1538356456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX Q1361) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 89562) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2014-12-12 |