| 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 |