| NPI | 1912985482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 14298) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 14298) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2007-07-09 |