| NPI | 1710042023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CO 45810) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 239972) |
| 208200000X Plastic Surgery (Licence: IL 036-110304) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-26 |