| NPI | 1366696072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NM MD2017-0533) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2017-0533) |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2026-06-11 |