| NPI | 1649774951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 338647) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD D0100632) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-09-09 |