| NPI | 1477517183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35083499d) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 264225) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2012-03-30 |