| NPI | 1730522061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA10287200) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 68908) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2022-08-25 |