| NPI | 1720261563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 257612) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 59579) |
| 208600000X Surgery (Licence: GA 59579) | |
| Enumeration Date | 2007-12-16 |
| Last Update Date | 2011-12-19 |