| NPI | 1083932073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 282375-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197461) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2019-03-15 |