| NPI | 1831348259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 252902-1) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD433499) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2015-02-06 |