| NPI | 1336248970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 222157) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 045603) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-08-28 |