| NPI | 1669564795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NE 16944) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G52089) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-09-25 |