| NPI | 1780619171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MB06848500) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 2137701) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-06-16 |