| NPI | 1891957148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 36605) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 270648) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-07-21 |