| NPI | 1760554190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX E8219) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 20580) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |