| NPI | 1033128921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ MA031417) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA03141700) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2025-01-19 |