| NPI | 1619258886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 287559) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD448452) |
| 208200000X Plastic Surgery (Licence: CA A117439) | |
| 208200000X Plastic Surgery (Licence: TX Q7866) | |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2023-03-11 |