| NPI | 1669686135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 43222) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME103523) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2011-06-08 |