| NPI | 1164565081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 112527) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 19192) |
| 208200000X Plastic Surgery (Licence: FL 24943) | |
| 208200000X Plastic Surgery (Licence: CA C31707) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-08 |