| NPI | 1982869533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD443530) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MT193995) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2011-09-08 |