| NPI | 1487681037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ DI02195300) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NJ 22DIO2195300) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2012-08-01 |