| NPI | 1679548606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 116131) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL me95080) |
| 208200000X Plastic Surgery (Licence: CA G 17969) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2007-07-08 |