| NPI | 1134108574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA04227000) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 145984-1) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2007-07-13 |