| NPI | 1659437861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 132170) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 132170) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2010-06-21 |