| NPI | 1124100599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME93100) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.091065) |
| 208200000X Plastic Surgery (Licence: NJ ma07880100) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-05-08 |