| NPI | 1780840173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA10040600) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D0071793) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 3365355) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD465603) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2025-05-16 |