| NPI | 1861579344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 104025) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL26209) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-09-05 |