| NPI | 1376779389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD457796) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA09279000) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2020-11-04 |