| NPI | 1407054109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08737800) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA08737500) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 41447) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2016-11-04 |