| NPI | 1639674856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 329438) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME169674) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-12-23 |