| NPI | 1780841320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 245027) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 56705) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2023-06-06 |