| NPI | 1861637225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 7850850-1205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 54236) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2011-09-22 |