| NPI | 1396892758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08443200) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 205527) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2009-01-29 |