| NPI | 1659577427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL OS12990) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA OS016148) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2015-11-30 |