| NPI | 1952517872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN 14833) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 0000014833) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2009-12-01 |