| NPI | 1235208059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2018-0517) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ MA58948) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2025-01-15 |