| NPI | 1912060344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA08788600) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX M4431) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD431750) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-05-11 |