| NPI | 1528295102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME132719) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MT195525) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2023-08-16 |