| NPI | 1831695279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA12607800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 324266) |
| 208200000X Plastic Surgery (Licence: OH 35.150669) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2026-06-05 |