| NPI | 1629073382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME106293) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL 106293) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 200401193) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2023-03-07 |