| NPI | 1386879880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 280332) |
| Additional Taxonomies | 174400000X Specialist |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD446281) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2021-10-05 |