| NPI | 1083707541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MAO8823900) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD066425L) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2017-02-01 |