| NPI | 1134148455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME89367) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: ME MD25993) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2025-05-06 |