| NPI | 1326093980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MT 171635) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 266214) |
| 208200000X Plastic Surgery (Licence: NY 266214) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2026-04-13 |