| NPI | 1003131053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 292312-1) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA10153500) |
| 208200000X Plastic Surgery (Licence: CA 142117) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2023-02-22 |