| NPI | 1134395668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 264689) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 264689) |
| 208600000X Surgery (Licence: NY 264689) | |
| 208600000X Surgery (Licence: PA MD460311) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD460311) | |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2023-01-12 |