| NPI | 1477824852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 92208) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD018362E) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-01-18 |