| NPI | 1194103648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME157378) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: RI LP03411) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2022-08-31 |