| NPI | 1750596979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN 45934) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 45934) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2016-04-22 |