| NPI | 1942464417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA10083000) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 25MA10083000) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2018-06-07 |