| NPI | 1306932058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 206224) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07248700) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-10-27 |