| NPI | 1720353725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY P79599) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA09061000) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2015-04-08 |