| NPI | 1649407370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX R8558) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 287346) |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2023-10-17 |