| NPI | 1891986089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N5227) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME111574) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2012-11-28 |