| NPI | 1912166919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME126066) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD433545) |
| 2086X0206X Surgery, Surgical Oncology (Licence: NJ 25MA08651300) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2022-02-24 |