| NPI | 1619907102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME125254) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD040870E) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-09-02 |