| NPI | 1003904681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08971900) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 243488) |
| 208200000X Plastic Surgery (Licence: PA MD424549) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-05-22 |