| NPI | 1316366461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 285018) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 279276) |
| 208600000X Surgery (Licence: NY 285018) | |
| 208600000X Surgery (Licence: MA 279276) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-05-26 |