| NPI | 1437263761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME0034009) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD012125E) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-07-27 |