| 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 |