| NPI | 1023112018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 120905) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC 7369) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2017-02-21 |