| NPI | 1396714804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NJ 25MA06361200) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 179032-1) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-03-29 |