| NPI | 1407833932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NJ 25MA08272800) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NY 238718) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2024-05-30 |