| NPI | 1891780888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301039963) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301039963) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2016-05-05 |