| NPI | 1760691406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08357500) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 220991) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2008-07-08 |