| NPI | 1285642595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 26163) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: RI MD06203) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2019-07-19 |