| NPI | 1508084062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME114367) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 218674) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2013-03-11 |