| NPI | 1316171572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 81027) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 277081) |
| Enumeration Date | 2009-05-03 |
| Last Update Date | 2022-07-06 |