| NPI | 1831426907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 158337) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 158337) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2009-12-18 |