| NPI | 1386821700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA09904900) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD436356) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2020-11-17 |