| NPI | 1245463058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME153259) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 277916) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2024-03-19 |