| NPI | 1316262462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME112048) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 255568) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2016-08-18 |