| NPI | 1003811233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA06432800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD041474E) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2018-08-29 |