| NPI | 1043400153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME99174) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07785200) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |