| NPI | 1144257825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 206876-1) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA G85144) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA G85144) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA G85144) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD050602L) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-05-02 |