| NPI | 1235205352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME162755) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101229013) |
| 208200000X Plastic Surgery (Licence: VA 0101229013) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2025-05-27 |