| NPI | 1578562658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 054310) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD063348L) |
| 208200000X Plastic Surgery (Licence: NE 22149) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-07-08 |