| NPI | 1013914464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD036919E) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07478400) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2019-11-06 |