| NPI | 1659343887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2006-00438) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 2086S0122X) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2008-10-13 |