| NPI | 1275744450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MS 20642) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD427106) |
| 208600000X Surgery (Licence: NJ 25MA10417400) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PA MD427106) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 59513) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 302577) | |
| 208200000X Plastic Surgery (Licence: GA 072112) | |
| 208600000X Surgery (Licence: MS 20642) | |
| Enumeration Date | 2007-05-27 |
| Last Update Date | 2020-06-12 |