| NPI | 1679713085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX E0371) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME 17519) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |