| NPI | 1659529907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101249883) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 25520701) |
| 208200000X Plastic Surgery (Licence: MD D69897) | |
| 208200000X Plastic Surgery (Licence: DC MD037908) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2019-12-26 |