| NPI | 1275929309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA11727000) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11727000) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2024-06-24 |