| NPI | 1902334287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA12615400) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT213619) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2025-08-11 |