| NPI | 1073776589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA08725200) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 234202) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 234202) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2017-07-14 |