| NPI | 1598853996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD044017-E) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA053619) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |