| NPI | 1679730907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2009-00275) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 11011245A) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2016-06-01 |