NPI | 1922397116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 149967) |
Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08865700) |
208600000X Surgery (Licence: PA MT189530) | |
208600000X Surgery (Licence: CA 149967) | |
Enumeration Date | 2011-03-29 |
Last Update Date | 2018-01-10 |