| NPI | 1710940788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 220561) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 2205611) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: NY 220561) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 220561) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2026-05-26 |