| NPI | 1780778522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 198000) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD046328L) |
| 208200000X Plastic Surgery (Licence: NJ 69053) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |