| NPI | 1689711186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CO 46634) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO 46634) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2008-05-14 |