| NPI | 1659477610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD00049126) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2005026727) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2011-04-06 |