| NPI | 1255776019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 333186) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10047063) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2025-05-28 |