| NPI | 1669678793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 5101017348) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 5101017348) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2015-08-06 |