| NPI | 1487895124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME106831) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA 182714) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2020-04-27 |