| NPI | 1710926548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME100894) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 056206) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2019-12-04 |