| NPI | 1770789448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A103459) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX M6619) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2009-06-26 |