| NPI | 1912069394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04854500) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: NJ 25MA04854500) |
| 207R00000X Internal Medicine (Licence: NJ 25MA04854500) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NJ 25MA04854500) | |
| 208600000X Surgery (Licence: NJ 25MA04854500) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2012-11-28 |