| NPI | 1659548279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MB09902000) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 283468) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2021-12-27 |