| NPI | 1902848047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 162343) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 162343) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 162343) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-01-06 |