| NPI | 1144421801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A119057) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME103236) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2016-07-29 |