| NPI | 1659606465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME128395) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A 114363) |
| 208600000X Surgery (Licence: CA A 114363) | |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2022-07-21 |