| NPI | 1518956002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MB07162600) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 34008382) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2025-04-02 |