| NPI | 1972895241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 261299-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 261299-1) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2011-05-05 |