| NPI | 1356698013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD473789) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA11102600) |
| Enumeration Date | 2012-08-12 |
| Last Update Date | 2024-11-04 |