| NPI | 1487835260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 046220) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 240739) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2018-04-12 |