| NPI | 1629194618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME98267) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 104466) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2014-04-21 |