| NPI | 1699201145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA11521100) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 25MA11521100) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2024-11-19 |