| NPI | 1659446557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 100169) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G19366) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2007-07-08 |