| NPI | 1184692097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME0047328) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 16095) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-03-19 |