| NPI | 1851521298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME136255) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A150815) |
| 208600000X Surgery (Licence: PA 28359959) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2023-02-08 |