| NPI | 1134271521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 182373) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 182373-1) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2015-03-05 |