| NPI | 1427253244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME160599) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A119840) |
| 208200000X Plastic Surgery (Licence: MO 2007016633) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2023-08-09 |