| NPI | 1417000845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 157786) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G68334) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2024-11-19 |