| NPI | 1336260512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 213698) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 252233-1) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2010-05-18 |