| NPI | 1891784138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 37325) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 28432) |
| 208200000X Plastic Surgery (Licence: WA MD60287429) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2013-07-31 |