| NPI | 1013118140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: IL 036133753) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 264044) |
| 208200000X Plastic Surgery (Licence: OH 35089315) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-12-10 |