| NPI | 1760823595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME155911) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 126832) |
| 208200000X Plastic Surgery (Licence: TN 54391) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME155911) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2022-10-25 |