| NPI | 1053392829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 4726681) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 4726681) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-02-11 |