| NPI | 1295941169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX M7486) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 240663) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 240663) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-10-01 |