| NPI | 1699823955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX P2664) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN7875) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2014-02-06 |