| NPI | 1841264447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 208801) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 041954) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2019-06-26 |