| NPI | 1275615825 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ MA53507) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD028642E) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2019-07-29 |