| NPI | 1881892529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 052813) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 65381) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2014-06-10 |