| NPI | 1487942009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME135792) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 390200000X) |
| 174400000X Specialist (Licence: CA a128991) | |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2023-01-04 |