NPI | 1679728307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA05499900) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA05499900) |
208200000X Plastic Surgery (Licence: NJ 25MA05499900) | |
208D00000X General Practice (Licence: NJ 25MAO54999000) | |
Enumeration Date | 2008-11-21 |
Last Update Date | 2022-02-14 |