| NPI | 1548285513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME78931) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: LA 016622) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |