| NPI | 1982765939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2016-00315) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101055546) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2016-06-09 |