| NPI | 1003099045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D68797) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 221470) |
| 208200000X Plastic Surgery (Licence: DC MD037864) | |
| 208200000X Plastic Surgery (Licence: VA 0101245191) | |
| 208200000X Plastic Surgery (Licence: PA MD433647) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2010-08-11 |