| NPI | 1861441644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL 154757) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME154757) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD020160E) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-03-29 |