| NPI | 1497937486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA09918500) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 245976) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2021-07-23 |