| NPI | 1831795327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MP00616900) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MP00616900) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2024-06-06 |