| NPI | 1366564460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ MA0822630) |
| Additional Taxonomies | 2086S0105X Surgery, Surgery of the Hand (Licence: NJ MA0822630) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NJ MA0822630) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ MA0822630) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |