| NPI | 1760589923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME99849) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO T2003010386) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-07-23 |