| NPI | 1073717666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 248812) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 248812-1) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 248812) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2015-04-30 |