| NPI | 1184860330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 32492) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25ma08468400) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2026-04-05 |