| NPI | 1679581524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA03675000) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 1452731) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |