| NPI | 1235294604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME170720) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 149739) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2025-08-21 |