| NPI | 1104835925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 95272) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC MD 33673) |
| 208200000X Plastic Surgery (Licence: VA 0101231653) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-03-18 |