| NPI | 1295959948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MI 4301081927) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301081927) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME103842) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2022-11-10 |