| NPI | 1750345104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 97541) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 153717) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2026-02-12 |