NPI | 1134532880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NJ 25MA11776800) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: OK 35698) |
Enumeration Date | 2014-06-10 |
Last Update Date | 2024-04-18 |