| NPI | 1053569269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 114489) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME114489) |
| 208200000X Plastic Surgery (Licence: PA MD016058E) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2021-08-11 |