| NPI | 1295816775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME138014) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD011041E) |
| 208200000X Plastic Surgery (Licence: TX S4408) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-05-20 |