| NPI | 1962444976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA0811800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 206666-1) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-03-12 |