| NPI | 1659699148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 342373) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MT 68938) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2026-03-16 |