| NPI | 1134532880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA11776800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OK 35698) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2024-04-18 |