| NPI | 1710103890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME98794) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 228606) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2023-07-03 |