| NPI | 1477759397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 245680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 047972) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2016-03-04 |