| NPI | 1649213281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A050365) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 25504) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-08 |