| NPI | 1780758425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 169680) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 169680) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2009-10-14 |