| NPI | 1598086910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 244762) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 283853) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2024-11-19 |