| NPI | 1497914212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME106843) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 60241538) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2019-02-15 |