| NPI | 1710111885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD 00075574) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC MD040885) |
| 208200000X Plastic Surgery (Licence: VA 0101253704) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2013-07-03 |