| NPI | 1982771697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A7361) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA 20A7361) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2014-06-12 |