| NPI | 1700141553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA11844500) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: NJ 25MA11844500) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2024-04-17 |