| NPI | 1699883181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA 9910) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: LA 9515) |
| 208200000X Plastic Surgery (Licence: CO 15754) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2007-07-08 |