| NPI | 1073840377 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08953800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME102004) |
| 208200000X Plastic Surgery (Licence: NY 275111) | |
| 208200000X Plastic Surgery (Licence: PA MD456957) | |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2018-03-26 |