| NPI | 1629265657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA08409800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 249420-1) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2022-10-13 |