| NPI | 1568646321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME143771) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D0067333) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2020-06-24 |