| NPI | 1962652198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD448869) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 250126) |
| 208200000X Plastic Surgery (Licence: NJ 25MA09763300) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2021-12-02 |