| NPI | 1023192135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TN MD36897) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 002958) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-03-22 |