| NPI | 1275558025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 218939) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA08037600) |
| 208200000X Plastic Surgery (Licence: NY 218939) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-07-05 |