| NPI | 1558597922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2016-01773) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 280524) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2016-09-02 |