| NPI | 1770761025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 046053) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 246657) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2018-05-14 |