| NPI | 1740230762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME109483) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX N2918) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2014-08-20 |