| NPI | 1073893822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 269587) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 0300434) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2023-06-12 |