| NPI | 1760617716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 104210) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 104210) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2011-08-01 |