| NPI | 1962472142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 87448) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000031978) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2016-06-16 |