| NPI | 1447679709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2024-02003) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MB10570400) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-09-12 |