| NPI | 1689851172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 256024) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA08738100) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2026-07-10 |