| NPI | 1992807705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD422370) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD422370) |
| 174400000X Specialist (Licence: NJ 25MA07689900) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA07689900) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2015-08-07 |