| NPI | 1801250493 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 316587) | 
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 1014963) | 
| Enumeration Date | 2016-04-08 | 
| Last Update Date | 2025-07-07 |