| NPI | 1326205238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME135896) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101248740) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 283325) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2022-05-11 |