| NPI | 1437612280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 336980) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AL 51139) |
| 208200000X Plastic Surgery (Licence: AL 51139) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2026-05-19 |