| NPI | 1760464754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD044013E) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA R8F79) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2008-03-13 |