| NPI | 1649393224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA09164600) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 282350) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A107881) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2016-01-06 |