| NPI | 1750721585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME146714) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL TRN19090) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2020-09-15 |