| NPI | 1609970821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DC MD043797) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO R1G65) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2016-06-13 |