| NPI | 1699124438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD477043) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA1148800) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-11-22 |