| NPI | 1225111917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 130762-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 1307628) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-03-30 |