| NPI | 1396732954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA06754500) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD479154) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 213775) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-09-13 |