| NPI | 1144315821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME128227) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME128227) |
| 208200000X Plastic Surgery (Licence: OH 35077172M) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME128227) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-05-29 |