| NPI | 1649264086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 16761) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WV 16761) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2009-03-10 |