| NPI | 1093987828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2022-02499) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 262386) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2023-05-10 |