| NPI | 1063589059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OR MD221411) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME143238) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-10-28 |