| NPI | 1952568750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AL 34110) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 242536) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2017-02-17 |