| NPI | 1811900426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 234485) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07827500) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2016-11-07 |