| NPI | 1477878205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA09369900) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 252127) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2015-06-10 |