| NPI | 1427264944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME 97250) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 237007-1) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD422549) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-11 |