| NPI | 1629093109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2012-00580) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0063910) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-09-04 |