NPI | 1114978079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 302495) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 302495) |
207Q00000X Family Medicine (Licence: PA MD061848L) | |
Enumeration Date | 2006-05-15 |
Last Update Date | 2021-04-26 |