| NPI | 1760541130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME114687) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN17777) |
| 208600000X Surgery (Licence: FL ME114687) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2017-11-16 |