| NPI | 1760416184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 209853) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07955900) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-02-23 |