| NPI | 1225097454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NJ 25MA07369000) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 201483-1) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-03-29 |