| NPI | 1184919102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME137256) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OK 28491) |
| 208200000X Plastic Surgery (Licence: FL ME137256) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2023-03-03 |