| NPI | 1255536686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NM A-1678-12) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 239282) |
| 208600000X Surgery (Licence: NY 239282) | |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2023-12-13 |