| NPI | 1629061908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA07215500) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07215500) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2015-02-11 |