| NPI | 1639177967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN MD18955) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN MD18955) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2007-11-16 |