| NPI | 1649268962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 91217) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35056970) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2022-08-11 |