| NPI | 1457411787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AL MD35067) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 19401) |
| 208600000X Surgery (Licence: PA MD420465) | |
| 208600000X Surgery (Licence: NY 234978-1) | |
| 208600000X Surgery (Licence: OH 098029) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2017-04-12 |