| NPI | 1710959572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA07712600) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 209574) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2015-12-28 |