| NPI | 1871688317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 028757) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 28757) |
| 208200000X Plastic Surgery (Licence: CA G86208) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-11-04 |