| NPI | 1174056980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA12327200) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A184635) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2024-10-29 |