| NPI | 1497919567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA09328500) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 269683-1) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2024-04-17 |