| NPI | 1275786089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A108348) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 237991) |
| 208200000X Plastic Surgery (Licence: NJ 25ma08778700) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2021-07-22 |