| NPI | 1871097758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA11401900) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 333368) |
| 208200000X Plastic Surgery (Licence: PA MD473746) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-12-06 |