| NPI | 1386062800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 310374) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 310374) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2025-10-23 |