| NPI | 1609030170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N0926) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N0926) |
| 208200000X Plastic Surgery (Licence: FL ME112090) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2015-06-12 |