| NPI | 1063770394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 280902) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 280902) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2026-08-01 |