| NPI | 1326542739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME168607) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA11929900) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-08-12 |