| NPI | 1811223514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A175444) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 292030) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2024-05-31 |