| NPI | 1952546533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 79642) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD440792) |
| 208600000X Surgery (Licence: FL ME122781) | |
| 208600000X Surgery (Licence: PA MT193449) | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2018-06-03 |