| NPI | 1932579851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 326279) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 1801095237) |
| 208600000X Surgery (Licence: NY 326279) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 326279) | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2023-12-06 |