| NPI | 1174679807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 269516-01) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD AJ4147357) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2024-02-15 |