NPI | 1831359421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA09395800) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 270044-1) |
Enumeration Date | 2008-06-17 |
Last Update Date | 2020-05-15 |