| NPI | 1609801612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 197465) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 197465) |
| 174400000X Specialist | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-04-27 |