| NPI | 1811143316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 66232) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 036.115100) |
| 208200000X Plastic Surgery (Licence: NY 257461) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2022-01-07 |