| NPI | 1942366968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 60-230577) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 230577) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2022-11-23 |