| NPI | 1487796777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 027865) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 142977-1) |
| 208200000X Plastic Surgery (Licence: CA A38639) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-08-24 |