| NPI | 1417287707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 293510) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB10124900) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2023-01-03 |