| NPI | 1831152719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA08346800) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD454217) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 219577) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-07-18 |